Effect of coadministration of dexamethasone with intrathecal morphine on postoperative outcomes after cesarean delivery

ObjectiveTo investigate the effect of intrathecal dexamethasone administered with intrathecal morphine at cesarean delivery on postoperative adverse effects and patient satisfaction.MethodsA triple-blind, randomized, placebo-controlled trial conducted between February 2008 and December 2009 of 120 pregnant women scheduled to undergo cesarean delivery. The patients were randomized into 2 groups: group 1 received 0.2 mg of intrathecal morphine plus 8 mg of intrathecal dexamethasone, while group 2 received 0.2 mg of intrathecal morphine plus 0.9% saline solution (placebo). The occurrence of postoperative nausea and vomiting (PONV), postoperative itching, number of vomiting attacks, and need for antiemetics were recorded in both groups. Overall patient satisfaction was also recorded.ResultsPONV was 3 times less likely to occur in the dexamethasone group than in the placebo group. When vomiting did occur, the number of attacks was lower in the dexamethasone group (23 vs 87 attacks; OR 0.26, 95% CI, 0.18–0.39). Administration of antiemetics was markedly lower in the dexamethasone group (18 vs 49 shots; OR 0.10, 95% CI, 0.04–0.23) and less postoperative itching was experienced (OR 0.39; 95% CI, 0.19–0.81). The dexamethasone group reported significantly higher mean overall satisfaction scores (77 ± 17 vs 51 ± 22; mean difference 26.00; 95% CI, 18.97–33.03).ConclusionIntrathecal administration of dexamethasone with morphine significantly decreased PONV and improved overall patient satisfaction after cesarean delivery.     

Effects of parity and mode of delivery on urinary incontinence among postmenopausal women in Taiwan

ObjectiveTo investigate the association between the prevalence of urinary incontinence and parity or mode of delivery among Taiwanese women aged 60 years or older.MethodsBetween July 1999 and December 2000, a nationwide epidemiologic study was conducted in Taiwan among 2410 women selected by a multistage random sampling method. Face-to-face interviews with 1517 women were conducted. The relationship between the prevalence of urinary incontinence and the number of vaginal deliveries or number of cesarean deliveries was assessed by frequency and Pearson χ² test using a significance level of less than 0.05. Logistic regression was used to investigate the significance of dichotomous dependent variables.ResultsDecades ago, most Taiwanese women (1435 of 1511 respondents, 94.97%,) gave birth via vaginal delivery and the rate of cesarean delivery was low (20 of 1513 respondents, 1.32%). Parity (odds ratio [OR], 2.42; 95% confidence interval [CI], 0.87–6.71; P = 0.091), vaginal delivery (OR, 0.76; 95% CI, 0.39–1.47; P = 0.408), and cesarean delivery (OR, 1.47; 95% CI, 0.59–3.70; P = 0.409) did not increase the risk of urinary incontinence.ConclusionThere was no association between urinary incontinence and parity or mode of delivery among Taiwanese postmenopausal women decades after their first delivery.     

High gestational weight gain and the risk of preterm birth and low birth weight: a systematic review and meta-analysis

ObjectiveMany women have high gestational weight gain (GWG), but potential neonatal consequences are not yet well quantified. We sought to determine the relationship between high GWG and preterm birth (PTB) and low birth weight (LBW) in singleton births.Data SourcesWe searched Medline and Embase and reference lists.Study SelectionTwo assessors independently performed all steps. We selected studies assessing high total or weekly GWG on PTB (< 37 weeks) and LBW (< 2500 grams).Data extraction and synthesisThirty-eight studies, 24 cohort and 14 case-control, were included involving 2 124 907 women. Most contained unadjusted data. Women with high total GWG had a decreased risk overall of PTB < 37 weeks (relative risk [RR] 0.75; 95% CI 0.60 to 0.96), PTB 32 to 36 weeks (RR 0.70; 95% CI 0.70 to 0.71), and < 32 weeks (RR 0.87; 95% CI 0.85 to 0.90). High GWG was associated with lower risk of LBW (RR 0.64; 95% CI 0.53 to 0.78). Women with the highest GWG had lower risks of LBW (RR 0.55; 95% CI 0.32 to 0.94) than women with moderately high GWG (RR 0.73; 95% CI 0.60 to 0.89). Women with the highest weekly GWG had greater risks of PTB (RR 1.51; 95% CI 1.47 to 1.55) than women with moderately high weekly GWG (RR 1.09; 95% CI 1.05 to 1.13). Women with high weekly GWG were at increased risk of PTB 32 to 36 weeks (RR 1.14; 95% CI 1.10 to 1.17 and < 32 weeks (RR 1.81; 95% CI 1.73 to 1.90).ConclusionAlthough women with high total GWG have lower unadjusted risks of PTB and LBW, high weekly GWG is associated with increased PTB, and more adjusted studies are needed, as are more studies in obese women. Potential benefits of high GWG for the infant must be balanced against maternal risks and other known infant risks such as high birth weight.     

The role of platelet counts in the assessment of inpatient women with preeclampsia

ObjectivePlatelet count has been proposed as a screening test for generalized coagulopathy in women with preeclampsia. We performed this study to determine the relationship between platelet counts and the risk of abnormal coagulation and adverse maternal outcomes in women with preeclampsia.MethodsWe used data from women in the PIERS (Pre-eclampsia Integrated Estimate of RiSk) database. Abnormal coagulation was defined as either an international normalized ratio result greater than and/or a serum fibrinogen level less than the BC Women’s Hospital laboratory’s pregnancy-specific normal range. The relationship between platelet counts and adverse maternal outcomes was explored using a logistic regression analysis. The sensitivity, specificity, positive predictive value, and negative predictive value of platelet counts in identifying abnormal coagulation or adverse maternal outcomes were calculated.ResultsAbnormal coagulation occurred in 105 of 1405 eligible women (7.5%). The odds of having abnormal coagulation were increased for women with platelet counts < 50 × 10⁹/L (OR 7.78; 95% CI 3.36 to 18.03) and between 50 and 99 × 10⁹/L (OR 2.69; 95% CI 1.44 to 5.01) compared with women who had platelet counts above 150 × 10⁹/L. Platelet counts < 100 × 10⁹/L were associated with significantly increased odds of adverse maternal outcomes, most specifically blood transfusion. A platelet count of < 100 × 10⁹/L had good specificity in identifying abnormal coagulation and adverse maternal outcomes (92% [95% CI 91% to 94%] and 92% [95% CI 91% to 94%], respectively), but poor sensitivity (22% [95% CI 15% to 31%] and 16% [95% CI 11% to 23%], respectively).ConclusionA platelet count < 100 × 10⁹/L is associated with an increased risk of abnormal coagulation and maternal adverse outcomes in women with preeclampsia. However, the platelet count should not be used in isolation to guide care because of its poor sensitivity. Whether or not a platelet count is normal should not be used to determine whether further coagulation tests are needed.     

Perinatal outcomes associated with subsequent pregnancy among adolescent mothers in Peru

ObjectiveTo assess the perinatal outcomes of a subsequent pregnancy among adolescent mothers living in Peru.MethodsA large hospital-based retrospective cohort study was conducted to evaluate singleton births during a 9-year period (2001–2009). The study population was divided into 3 groups: adolescents aged 15–19 years who had 1 previous parturition (n = 2074), nulliparous adolescents (n = 20 721), and multiparous adults aged 20–29 years (n = 23 129).ResultsNo significant differences were found between multiparous adolescents and the 2 control groups with regard to preterm delivery, perinatal death, and 5-minute Apgar score below 7. Logistic regression analysis showed no significant differences in the rates of cesarean delivery or preterm birth before 34 or 37 weeks. After adjusting for confounding factors, low birth weight (LBW) and small for gestational age (SGA) were more likely to occur during a subsequent pregnancy among adolescent mothers than during the 1st pregnancy among nulliparous adolescents. The odds ratios were 1.38 (95% CI, 1.14–1.67) and 1.27 (95% CI, 1.02–1.56), respectively.ConclusionMultiparous adolescents are more likely to experience LBW or SGA than are nulliparous adolescents. No significant differences in other perinatal outcomes were found among the 3 study groups.     

Female Urinary Incontinence at Orgasm: A Possible Marker of a More Severe Form of Detrusor Overactivity. Can Ultrasound Measurement of Bladder Wall Thickness Explain It?

IntroductionCoital incontinence (CI) during orgasm is a form of urinary incontinence possibly because of detrusor overactivity (DO), as the underlying pathophysiological condition. Women with this symptom usually show a pharmacological lower cure rate than those with DO alone. The ultrasound measurement of the bladder wall thickness (BWT) allows an indirect evaluation of detrusor muscle thickness, giving a potential index of detrusor activity.AimWe wanted to understand if CI at orgasm could be a marker of severity of DO by comparing BWT in women with both DO and CI at orgasm vs. women with DO alone. In addition we aimed to confirm if CI during orgasm is related to antimuscarinics treatment failure.MethodsThis is a prospective cohort study performed in two tertiary urogynecological referral departments, recruiting consecutive patients seeking treatment for symptomatic DO.Main Outcome MeasuresAll patients were thoroughly assessed including physical examination, urodynamic evaluation, and BWT measurement according to the International Continence Society/International Urogynecological Association and ICI recommendations. Solifenacine 5 mg once daily was then prescribed and follow-up was scheduled to evaluate treatment. Multiple logistic regression (MLR) was performed to identify risk factors for treatment failure.ResultsBetween September 2007 and March 2010, 31 (22.6%) and 106 (77.4%) women with DO with and without CI at orgasm were enrolled. Women complaining of CI at orgasm had significantly higher BWT than the control group (5.8 ± 0.6 mm vs. 5.2 ± 1.2 mm [P = 0.007]). In patients with CI at orgasm, the nonresponder rate to antimuscarinics was significantly higher than controls (P = 0.01). After MLR, CI at orgasm was the only independent predictor decreasing antimuscarinics efficacy (odds ratio [OR] 3.16 [95% CI 1.22–8.18], P = 0.02).ConclusionsWomen with DO and CI at orgasm showed a significantly higher BWT values and worse cure rates than women with DO alone. CI at orgasm could be a marker of a more severe form of DO. Serati M, Salvatore S, Cattoni E, Siesto G, Soligo M, Braga A, Sorice P, Cromi A, Ghezzi F, Cardozo L, and Bolis P. Female urinary incontinence at orgasm: A possible marker of a more severe form of detrusor overactivity. Can ultrasound measurement of bladder wall thickness explain it?.     

The Pulmonary Edema Preeclampsia Evaluation (PEPE) Study

BackgroundWomen with preeclampsia may develop pulmonary edema, but the reasons for this are largely unknown.MethodsWe performed a case–control study of women with preeclampsia at two major obstetrical centres in Toronto, ON, between 2005 and 2012. Cases (n = 28) were women with preeclampsia who had pulmonary edema on a chest CT or plain X-ray during the index delivery hospitalization. Control subjects (n = 64) were those with preeclampsia but no diagnosis of pulmonary edema or heart failure in the index hospitalization for delivery. Study variables were abstracted from each woman’s paper chart and electronic medical record. Multivariable logistic regression with backward elimination was used to select a final set of significant predictors.ResultsApproximately one half of the cases of pulmonary edema occurred antepartum. Each 10 × 10⁹/L reduction in platelet count (OR 1.32; 95% CI 1.06 to 1.65) or 10 μmol/ L increase in peak serum uric acid concentration (OR 1.19; 95% CI 1.06 to 1.34) was significantly associated with pulmonary edema, as was receiving magnesium sulphate (OR 10.42; 95% CI 1.39 to 78.22). Multiparity (OR 0.03; 95% CI 0.004 to 0.29) and each 500 mL increase in the volume of intravenous crystalloids received (OR 0.60; 95% CI 0.37 to 0.98) were associated with a lower risk of pulmonary edema.ConclusionWe identified several preliminary risk factors for pulmonary edema in women with preeclampsia. Additional work is needed to better understand the role of these and other factors predicting the development of pulmonary edema in women with preeclampsia.     

Placental mRNA in maternal plasma as a predictor of ectopic pregnancy

ObjectiveTo measure and compare placental mRNA expression in the maternal circulation among women with intrauterine and ectopic pregnancies.MethodsPlasma was collected from patients in early pregnancy at risk of ectopic pregnancy. Clinical information was prospectively collected and entered into a dedicated database. mRNA was isolated from maternal plasma and quantitative RT-PCR was performed to measure mRNA for human gonadotropin (hCG) and human placental lactogen (hPL). GAPDH mRNA expression was used as an internal control.ResultsTwelve women with ectopic pregnancy and 13 women with intrauterine pregnancy were enrolled. Patients with ectopic pregnancy were 6 times more likely to have undetectable levels of hPL mRNA (relative risk [RR] 6.36; 95% confidence interval [CI], 1.70–23.20; P < 0.01). They were also 8 times more likely to have undetectable levels of hCG mRNA (RR 8.64, 95% CI, 1.30–57.10; P < 0.01). mRNA copy numbers for hPL and hCG (normalized by GAPDH) were significantly lower in the ectopic group than in the intrauterine group.ConclusionPlacental mRNA is present in the maternal circulation in significantly lower copies in cases of ectopic pregnancy compared with cases of intrauterine pregnancy. Measurement of placental mRNA in the maternal circulation may help to distinguish between intrauterine and ectopic pregnancies.     

Rupture of membranes in case of internal podalic version: a risk for cesarean section on the second twin

ObjectivesTo evaluate if internal version with ruptured membranes is a risk factor of cesarean section for the second twin.Patients and methodsTwo hundred and fifty-nine twins vaginal deliveries after 33 weeks of gestation from 1997 to 2009 in a level 3 maternity. A retrospective case–control study comparing two groups: cases of cesarean section on second twin and five twins vaginal deliveries following the case. Active management of the second twin delivery was performed with a short intertwin delivery.ResultsEleven cesarean sections on the second twin were performed (4.2%). The main indication was failure of internal version. The risk of cesarean section was significantly greater when the internal version was performed with ruptured membranes (OR: 25.4 IC 95% [2.3–275.7] P < 0.003) and when intertwin time delivery interval was increased (8.1 ± 5.1 vs 16.7 ± 6.3, P < 0.001).Discussion and conclusionThe rupture of amniotic membranes before or during the internal podalic version is associated with a risk of failure and cesarean for the second twin. We recommend to perform the internal podalic version with unruptured membranes according to the French recommendations.     

Perinatal complications and cesarean delivery among foreign-born and Australian-born women in Western Australia, 1998-2006

ObjectiveTo determine whether common perinatal complications could explain variation in risk of cesarean among foreign-born and Australian-born women in Western Australia (WA).MethodsComplication prevalence was calculated using the linked records of 208 982 confinements to non-indigenous women in WA between 1998 and 2006. Logistic regression was used to estimate differences in risk of elective cesarean and emergency cesarean compared with vaginal delivery for foreign-born women from different regions.ResultsThe most common complications in emergency cesareans were failure to progress (36.7%) and fetal distress (35.7%). The most common complications in elective cesareans were previous cesarean (56.2%) and malpresentation (16.3%). Women from Sub-Saharan Africa, Southeast Asia, and Southern and Central Asia had an increased risk of emergency cesarean compared with Australian-born women (P < 0.05), whereas women from Oceania, North Africa and the Middle East, and Northeast Asia had a decreased likelihood of elective cesarean compared with Australian-born women (P < 0.05).ConclusionComplication prevalence varied by maternal region of birth. However, variation in these complications does not completely explain differences in mode of delivery among foreign-born and Australian-born women in WA. Sociocultural factors must be considered in future research and when establishing culturally appropriate guidelines for obstetric staff dealing with foreign-born women.     

Association of hemoglobin values at booking with adverse maternal outcomes among Peruvian populations living at different altitudes

ObjectiveTo determine hemoglobin values associated with adverse maternal outcomes among Peruvian populations at different altitudes.MethodsA retrospective cohort study was conducted using data from the Perinatal Information System. Adverse maternal outcomes were assessed.ResultsRisk of pre-eclampsia increased at maternal hemoglobin levels above 14.5 g/dL (OR 1.27; 95% CI, 1.18–1.36) or below 7.0 g/dL (OR 1.52; CI 95%, 1.08–2.14). Altitude above 2000 m reduced risk (OR 0.65; 95% CI 0.62–0.68). Risk of postpartum hemorrhage (PPH) increased with moderate/severe anemia (OR 6.15; 95% CI, 3.86–9.78) and at moderate altitudes (OR 1.26; 95% CI, 1.12–1.43). Mild anemia at any altitude was associated with reduced risk of pre-eclampsia (OR 0.85, 95% CI, 0.81–0.89) and PPH (OR 1.01; 95% CI, 0.88–1.15). Risk of premature rupture of membranes was reduced at high hemoglobin values. Maternal mortality increased at hemoglobin levels below 9.0 g/dL (OR 5.68; 95% CI, 2.97–10.80) and above 14.5 g/dL (OR 2.18; 95% CI, 1.22–3.91). Maternal mortality increased at moderate altitudes (OR 29.2; 95% CI, 2.62–324.60) and high altitudes (OR 66.4; 95% CI, 6.65–780.30) when hemoglobin levels were below 9.0 g/dL.ConclusionElevated altitude and hemoglobin levels influence maternal outcomes.     

Patient Satisfaction with Informed Consent for Cesarean and Operative Vaginal Delivery

ObjectiveTo evaluate patient satisfaction with the informed consent process for elective cesarean delivery (CD), emergency CD, and operative vaginal delivery (OVD).MethodsA cross-sectional, survey-based study was conducted among patients on the postpartum floor of our institution. Patients were approached after delivery to complete a previously pilot-tested questionnaire, based on validated literature. One hundred eighty-four surveys were included in the analysis. Levels of patient satisfaction were compared across modes of delivery using χ² tests of independence. Secondary objectives included evaluating the relationship between satisfaction scores and the patient’s recall of the consent process and emotional state during the consent process.ResultsA significant association was found between patient satisfaction with the consent process and mode of delivery (P < 0.001). Those in the elective and emergency CD groups were significantly more likely to express high rates of satisfaction compared with those in the OVD group (odds ratio [OR] 9.03; 95% CI 2.80–29.10 and OR 3.97; 95% CI 1.34–11.76, respectively). High levels of satisfaction were significantly more common among those who had greater recall of the consent process (OR 25.2; 95% CI 7.34–87.04) and those who reported low levels of distress during the process (OR 15.1; 95% CI 4.70–48.66).ConclusionInformed consent during OVD is associated with lower rates of patient satisfaction compared with CD. Efforts are needed to improve the consent process for OVD to increase patient satisfaction and promote patient-centred care.     

The Effects of Prenatal Secondhand Smoke Exposure on Preterm Birth and Neonatal Outcomes

ObjectiveTo examine the relationship between prenatal secondhand smoke (SHS) exposure, preterm birth and immediate neonatal outcomes by measuring maternal hair nicotine.DesignCross‐sectional, observational design.SettingA metropolitan Kentucky birthing center.ParticipantsTwo hundred and ten (210) mother–baby coupletsMethodsNicotine in maternal hair was used as the biomarker for prenatal SHS exposure collected within 48 hours of birth. Smoking status was confirmed by urine cotinine analysis.ResultsSmoking status (nonsmoking, passive smoking, and smoking) strongly correlated with low, medium, and high hair nicotine tertiles (ρ=.74; p<.001). Women exposed to prenatal SHS were more at risk for preterm birth (odds ratio [OR]=2.3; 95% Confidence Interval [CI] [.96, 5.96]), and their infants were more likely to have immediate newborn complications (OR=2.4; 95% CI [1.09, 5.33]) than nonexposed women. Infants of passive smoking mothers were at increased risk for respiratory distress syndrome (RDS) (OR=4.9; 95% CI [1.45, 10.5]) and admission to a Neonatal Intensive Care Unit (NICU) (OR=6.5; CI [1.29, 9.7]) when compared to infants of smoking mothers (OR=3.9; 95% CI [1.61, 14.9]; OR=3.5; 95% CI [2.09, 20.4], respectively). Passive smokers and/or women with hair nicotine levels greater than .35 ng/ml were more likely to deliver earlier (1 week), give birth to infants weighing less (decrease of 200‐300 g), and deliver shorter infants (decrease of 1.1‐1.7 cm).ConclusionsPrenatal SHS exposure places women at greater risk for preterm birth, and their newborns are more likely to have RDS, NICU admissions, and immediate newborn complications.     

Comparison of intrapartum outcome among immigrant women from Ethiopia and the general obstetric population in Israel

ObjectiveTo compare intrapartum outcome between ethnic Ethiopian women and the general obstetric population in Israel.MethodsIn a retrospective study, computerized data from all Ethiopian women who delivered between January 2004 and August 2011 at a university teaching hospital in Afula, Israel, were assessed. The control group comprised non-Ethiopian Israeli women, who were matched at a ratio of 1:2 on the basis of deliveries that took place immediately before and after delivery by an Ethiopian woman. The primary outcome was incidence of operative delivery.ResultsDuring the study period, 576 Ethiopian women delivered along with 1152 matched control women. Ethiopian women had a higher incidence of pre-eclampsia (6.8% versus 4.0%, P = 0.01) and early postpartum hemorrhage (4.3% versus 1.6%, P = 0.003) than control women. After adjustment for potential confounders, the incidence of vacuum or cesarean delivery was significantly higher among Ethiopian than among control women (odds ratio, 1.68; 95% confidence interval, 1.28–2.20; P = 0.002). The incidence of composite major perinatal morbidity, including Erb palsy and cord pH less than 7.1, tended to be higher among Ethiopian women than among control women (2.3% versus 1.1%; P = 0.053).ConclusionAlthough prepartum and intrapartum care are standardized, Ethiopian women had a less favorable intrapartum outcome.     

The Combined Effect of Maternal Obesity and Fetal Macrosomia on Pregnancy Outcomes

ObjectiveTo examine the combined effect of macrosomia and maternal obesity on adverse pregnancy outcomes using a retrospective cohort.MethodsInfants with a birth weight of ≥ 4000g (macrosomia) were identified from an institutional birth cohort. Demographic characteristics and maternal, fetal, neonatal, and pregnancy outcomes of macrosomic infants whose mothers were obese were compared with those whose mothers were non-obese.ResultsPregnancies in obese women resulting in macrosomic infants are more likely to be complicated by gestational diabetes, gestational hypertension, and smoking than pregnancies in non-obese women with macrosomic infants. Mothers whose infants are macrosomic are significantly more likely to require induction of labour (OR 1.42; 95% CI 1.10 to 1.98) and delivery by Caesarean section (OR 1.45; 95% CI 1.04 to 2.01), particularly for maternal indications (OR 3.7; 95% CI 1.47 to 9.34), if they are obese. Finally, macrosomic infants of obese mothers are significantly more likely to require neonatal resuscitation in the form of free flow oxygen (OR 1.57; 95% CI 1.03 to 2.42) than macrosomic infants of non-obese mothers.ConclusionWhen both maternal obesity and macrosomia are present, adverse pregnancy outcomes are more common than when fetal macrosomia occurs in a woman of normal weight.     

Comparison of laparoscopy and laparotomy for endometrial cancer

ObjectiveTo compare the safety and efficacy of laparoscopy and laparotomy on clinical outcomes among patients with endometrial cancer.MethodsEligible randomized controlled trials (RCTs) conducted between 1966 and June 2010 were analyzed by meta-analysis.ResultsEight RCTs were included, with 3599 patients in total. No significant difference was observed between laparoscopy and laparotomy in overall (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.50–1.82; P = 0.892), disease-free (OR, 0.96; 95% CI, 0.50–1.82; P = 0.892), or cancer-related (OR, 0.90; 95% CI, 0.27–3.08; P = 0.871) survival. More intraoperative complications (OR, 1.33; 95% CI, 1.03–1.73; P = 0.030), fewer postoperative complications (OR, 0.59; 95% CI, 0.46–0.75; P < 0.001), longer operative time (standardized mean difference [SMD], 0.80; 95% CI, 0.46–1.15; P < 0.001), lower blood loss (SMD, –2.29; 95% CI, –3.67 to ? 0.91; P = 0.001), and shorter hospital stay (SMD, –2.60; 95% CI, –3.47 to ? 1.72; P < 0.001) were associated with laparoscopy. There was no significant difference between the groups in pelvic (SMD, 0.22; 95% CI, –0.03 to 0.48; P = 0.086) or para-aortic (SMD, 0.54; 95% CI, –0.04 to 1.11; P = 0.067) lymph node yield.ConclusionLaparoscopy has short-term advantages and seemingly equivalent long-term outcomes and, in experienced hands, might be a feasible alternative to laparotomy for endometrial cancer.     

Valores extremos del IMC materno: factores determinantes de peores resultados obstétricos y perinatales

ObjectiveTo study the influence of maternal body mass index (BMI) at the beginning of pregnancy on obstetric-perinatal outcomes.Material and methodsObservational-ambispective study. We recruited 1407 patients with singleton gestations and deliveries of foetuses > 24 weeks between 01/12/2017 and 31/07/2019. The sample was stratified according to their BMI following the WHO classification. Variables on pre-pregnancy, gestational disease, obstetric care, and maternal-perinatal outcomes were analysed and compared between the studied groups. The statistical program has been R Core Team 2020, version 3.6.3. P ≤ .05 was considered significant.ResultsClass II-III (BMI 35-39 and BMI ≥ 40 respectively) obese women have a higher risk of chronic arterial hypertension (OR 53.54, 95% CI 18.21-229.02), gestational diabetes (OR 5.24, 95% CI 2.87-9.51) and preeclampsia (OR 2.38, 95% CI 0.95-5.51 with P = .049). The underweight women had more intrauterine growth restriction diagnoses (OR 3.09, 95% CI 1.46-6.17). Inductions of labour and caesarean sections increase as BMI increases (P = .006). Low weight patients also had a higher risk of caesarean section (OR 2.46, 95% CI 1.06-5.20). Neonatal admissions were more frequent in obese and underweight women (OR 2.68, 95% CI 1.39-5.00 and OR 2.56, 95% CI 1.10-5.44 respectively). Obese women had a higher risk of neonatal weight > 4000 g (OR 3.06, 95% CI 1.57-5.77) and low weight pregnant women had a higher risk of neonatal weight < 2500 g (OR 2.94, 95% CI 1.54-5.41).ConclusionExtreme values of maternal BMI at the beginning of gestation are determining factors for an adverse obstetric-perinatal outcome.     

Why Do Canadian Women Fail to Achieve Optimal Pre-Conceptional Folic Acid Supplementation? An Observational Study

ObjectivesTo determine the factors that put Canadian women at risk for not supplementing with folic acid (FA) in the three months before conception, as recommended for the prevention of infant neural tube defects.MethodsThis study used data from the Canadian Maternity Experiences Survey. We used Poisson regression analysis with a robust variance to determine which factors were associated with women not supplementing with FA in the three months prior to pregnancy as compared with women who did supplement.ResultsOf the 6421 women surveyed, 57.7% were supplementing with FA pre-conceptionally. The risk factors associated with a lack of FA supplementation pre-conceptionally were maternal age < 19 (prevalence ratio [PR] = 0.50; 95% CI 0.36 to 0.69) or 20 to 24 (PR = 0.75; 95% CI 0.67 to 0.84); education below high school level (PR = 0.73; 95% CI 0.61 to 0.87), at high school level (PR = 0.77; 95% CI 0.71 to 0.83), or at post-secondary level other than university (PR = 0.93; 95% CI 0.88 to 0.97); being at or below the low-income cut-off (PR = 0.74; 95% CI 0.67 to 0.81); smoking before pregnancy (PR = 0.79; 95% CI 0.73 to 0.86); being non-fluent in the language of the health care provider (PR = 0.66; 95% CI 0.49 to 0.88); being obese (BMI ≥ 30) (PR = 0.91; 95% CI 0.85 to 0.98); being unemployed (PR = 0.94; 95% CI 0.89 to 1.00); and being born outside of Canada (PR = 0.79; 95% CI 0.74 to 0.84).ConclusionYoung maternal age, low education, low income, smoking, language barriers, obesity, unemployment, and being born outside Canada are risk factors for suboptimal or lack of FA supplementation pre-conceptionally.     

Prediction of Preterm Birth in Multiple Pregnancies: Development of a Multivariable Model Including Cervical Length Measurement at 16 to 21 Weeks’ Gestation

ObjectiveTo develop a multivariable prognostic model for the risk of preterm delivery in women with multiple pregnancy that includes cervical length measurement at 16 to 21 weeks’ gestation and other variables.MethodsWe used data from a previous randomized trial. We assessed the association between maternal and pregnancy characteristics including cervical length measurement at 16 to 21 weeks’ gestation and time to delivery using multivariable Cox regression modelling. Performance of the final model was assessed for the outcomes of preterm and very preterm delivery using calibration and discrimination measures.ResultsWe studied 507 women, of whom 270 (53%) delivered < 37 weeks (preterm) and 66 (13%) < 32 weeks (very preterm). Women with cervical length < 30 mm delivered more often preterm (hazard ratio 1.9; 95% CI 0.7 to 4.8). Other independently contributing predictors were previous preterm delivery, monochorionicity, smoking, educational level, and triplet pregnancy. Prediction models for preterm and very preterm delivery had a c-index of 0.68 (95% CI 0.63 to 0.72) and 0.68 (95% CI 0.62 to 0.75), respectively, and showed good calibration.ConclusionIn women with a multiple pregnancy, the risk of preterm delivery can be assessed with a multivariable model incorporating cervical length and other predictors.     

The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan

ObjectiveTo compare 2 routine obstetric ultrasound protocols regarding number of clinically relevant events detected and total ultrasound workload.MethodsAn interventional before-and-after study comparing 2 groups of 750 consecutive low-risk pregnant women was conducted. The 1st group was routinely offered mid-trimester ultrasound and selective ultrasound examinations for specific indications; the 2nd group was, in addition to this, offered a scan at 1st prenatal visit.ResultsThe groups were comparable at baseline, and 78% underwent booking scan. The expanded protocol showed no improvement in detection of most clinically relevant findings but did detect twins slightly earlier (P = 0.3) and significantly reduced the number of presumed post-term deliveries (8.4% vs 13.1%; OR 0.61 [95% CI, 0.41–0.90]). Although more women were scanned at any point or < 24 weeks (P < 0.001), the increase in women receiving a properly timed fetal anomaly scan was small (60.7% vs 52.3%; P = 0.003). Total ultrasound workload increased by 74%, mainly because of more follow-up scans (323 vs 122) and more women being scanned for the 1st time > 24 weeks (146 vs 51; P < 0.001).ConclusionThe results do not support a policy of routine booking scans and revealed no significant benefit apart from a small reduction in presumed post-term pregnancies.